T Nation

Tight SI Joint


#1

I've been having some pain in my sacrum following a back injury that occurred a little over five months ago. I saw a chiropractor and after some imaging, he determined that I have a tight Sacroiliac Joint on both sides.

I'm currently getting some realignment done several times a week, but unfortunately this treatment does not help me understand what the initial cause of my SI Joint tightness was, or how I can prevent similar issues in the future.

Does anyone have any input or experience with SI Joint dysfunction? Are there any stretces or remedial exercises I can do on my own to increase my SI Joint mobility?


#2

SIJD can be caused by a multitude of things, including but not limited to tight hip flexors, inhibited glutes/hip extensors, tight piriformis, over-active QL/lumbar paraspinals, poor hip IR, poor hip ER, restricted/tight adductors, weak abductors, poor thoracic ROM, weak lumbar stabilizers, damage to your SI joint ligaments, excessive scar tissue from prior injuries.

I guess my point is, based off of the information given, it is very difficult to give you advice to your specific condition. For a generic/generalized answer, I would say strengthen your hip extensors and lumbar stabilizers, address mobility of your hips, thoracic spine and ankles, and work on hip IR and ER ROM.

I'd suggest finding a practitioner who is going to do a full functional assessment and provide you with rehabilitation and not just passive adjustments. Chiropractic mobilizations/adjustments are great, but if you don't fix the underlying cause you will continue to return to the restricted positions.


#3

Thanks for the response! I definitely agree with the idea of fixing the underlying cause, which is why I am trying to understand some of the factors that contribute to dysfunction at the SI Joint.
I used to have just about every problem you listed - my hip flexors were very tight, my glute recruitment was terrible, and my hip mobility was very poor. Additionally my lifting mechanics were terrible, especially on movements like the deadlift and squat. I've been spending a lot of time over the past year and a half on correcting my length-tension imbalances, mobility issues, and lack of recruitment of core and gluteal muscles.
I've been able to address most of the problems that I've had, but I still have a couple of issues that I haven't made much progress with - mostly hip internal rotation ROM and adductor flexibility and tissue quality. Do you have any suggestions (stretches, remedial movements, etc.) on how I could improve those issues?


#4

For hip internal rotation, I am a fan of the lying knee to knee stretch. But you also have to determine whether it is a muscular restriction or a capsular restriction for hip IR ROM. A good physical therapist, athletic trainer, or other rehab specialist/movement specialist should be able to help you with determining that.

In terms of adductor mobility, I am a fan of the split stance adductor mobs, 1/2 kneeling adductor dips, deep squat holds, and the squat to stand drill. For tissue quality, foam rolling at various angles of hip abduction and flexion/extension will help (I will perform it on the floor and then with the foam roller/leg propped up on a table), you can use a tiger tail/stick as well, and for more precise work seek out a good Graston, ART, or ROLF practitioner.


#5

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#6

I've looked up videos for those remedial movements you've suggested, and I'll implement them asap. I've had a hard time hitting my adductors very well with the myofacial release, but doing it standing with your hip abducted on a table seems like a creative solution. I'll give that a shot.
Thanks again for the input!


#7

Hi BBB.
You're exactly right - the imaging was X-rays, and the only other things he did were a short and ineffective assessment of my posture and hip ROM. (Just as an aside, I felt significantly more discomfort than usual after his assessment of my hip mobility.)
At the time, I didn't know how he was able to diagnose a tight SIJ based on X-ray - it seems like he may have just been looking for something to diagnose. I was definitely suspicious from the start. I respect your opinion more than this chiropractor's.


#8

See the above video for a visual example of how to perform the table top adductor foam rolling. I use the same set up, but will perform the foam rolling with the knee bent and straight. I will also rotate the hip in order to hit the adductor muscles at various angles and target the fascial connections/adhesions that will develop between the hip flexors/hip extensors and adductors.


#9

I had this problem, or something similar. For 6 years. And I did all the good things mentioned in this thread so far. However, I could not get rid of the SI pain.

What finally worked was this. I started doing the seated adductor and abductor machines at a gym I had just joined. I made sure to get my spine solid, stable, and neutral against the seat back, feel my sit-bones anchored on the seat, and imagine 'tractioning' my hips as I do the movement (as if the hips are being pulled out of the socket, away from the torso).

I also make sure that my abs stay fully braced through the whole movement (they did not automatically want to do this). I emphasize the resistance in the extremes of the ROM, almost like an isometric contraction. I do NOT train these for strength OR hypertrophy, so I don't try to greatly increase the weight, nor do I go anywhere near failure or even much fatigue. I just want these stubborn muscles activated and working in a much greater ROM than they had before.

I started every training session with these 2 machines, and in less than ONE WEEK, the SI pain which I have had for 6 years disappeared and has not come back.

A number of other things I did at the same time might have also helped, but I believe that the adductor machine is most responsible for the improvement (resistance when moving toward the midline).

Before using these machines, I had done all the adductor mobility drills for months from the sources already mentioned in this thread, and the soft-tissue stuff. I have a ton of respect for these guys, but it was the machines isolating those muscles, in a seated position with the spine supported, that promptly fixed my SI joint pain and constantly sore piriformis. 6 months later, I am still free of SI joint pain even though for one month I didn't train due to vacation and traveling, and for another month due to health and being in the hospital.


#10

Andersons, what you have explained is a pretty good advice, although I am not a big advocate for the seated adductor/abductor machines. Using them for activation work is better than for any other purpose though. I think in your situation, it was a combination of hip musculature activation with active core bracing/lumbar stability, and most likely more of the relief had to due with the increased active lumbar stability.

Other similar options one can do if they do not have access to or don't choose to use a hip abductor/adductor machine include other lumbar stability exercises that incorporate hip musculature activation:
-Fire hydrants, Glute alphabets, Side plank with hip abduction/adduction are all good options.


#11

That video was really helpful. Thanks for posting it.

As far as Andersons' experience - I've recently incorporated hip abduction and external rotation movements with a band around my knees, and they've been quite helpful. I also try to brace my abdominals when I execute the movement, although I do them in a lying position.

This makes me wonder whether it would be advantageous to also try to find exercises that involve resisted adduction and internal rotation of the hip. I would guess that the answer to that question would depend on whether or not my adductors and other muscles that contribute to internal rotation were weak or functioning improperly.


#12

I agree with the statement about the chiropractor. Based on what I've read about movement impairment syndromes, you want your SI joint to be as stable as possible. Dysfunction comes when that gets loosened up.


#13

LH, I did ALL those things every days for months on end. Plus lots more. Tons of lumbar stability stuff. But those helped only minimally. Plus the cost:benefit ratio was way too high. I was dedicated and spent hours each day doing all sorts of soft tissue work and mobilizations and lumbar stability from the sources mentioned here for about 5 months. It helped a bit, in that I could stand for 2 hours (instead of 1) or walk for 20 minutes before pain set in, but all of that work did NOT eliminate the SI pain.

Some of the other things I did for adductors included standing work with bands, isometrics, all the stuff in Cressey/Robertson/Hartmann, etc.

All I know is there was a profound and immediate difference in the pain when using the adductor machine as I described above. The machine quickly reset or 'rebooted' the length-tension relationships of the adductors and abductors -- after just 2-3 sessions, the change was virtually PERMANENT. None of those alternatives feel remotely similar to the end-ROM resistance of the adductor machine. I don't know why you or some other trainers do not recommend the machine, but I know for a fact that it quickly fixed up my chronic SI joint pain that I had had for 6 years.

I'm not saying that what I did will work for everyone with SI joint pain. There might be other causes different from mine. I don't even know if other specific machines would work as well; my gym has a Hoist Roc-It model. But for anyone with tight adductors, I highly recommend a seated adductor machine. If you pay just as much attention to form as you would with a band or free-weight movement, start with light weight and focus on increasing ROM, I don't see how it could possibly hurt anything. And if you're anything like me, it could fix you up quickly.


#14

Andersons, I'm glad it worked for you and am not doubting that it turned your pain around. I'm not saying it wouldn't work but I just feel MOST people would get better "bang for their buck" with the exercises I had mentioned. With most SI Joint issues, lumbar stability and glute activation are major issues and you won't fully address them doing the seated adductor/abductor machine. Question for you though, when you say "end-ROM resistance" for the adductor machine, do you mean end ROM into abduction or into adduction? With you, you may have actually self-manipulated your SI joint and activated your needed musculature while using the adductor and abductor machine since it can provide more resistance.

Again, I hope I didn't come off as downplaying what helped you out. I was just trying to point out that in most situations, somebody is going to benefit more from other exercises, but there was nothing wrong with your approach.


#15

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#16

Andersons, I am very interested in your experience. I was wondering if the very exercises you described would benefit these types of problems. It makes sense from a "common sense" point of view. Were you very specific in the speed at which you contracted and relaxed? What I'm getting at, is doing a sort of resisted eccentric. I'm contemplating doing these with a relatively quick concentric and about a four second eccentric for sets of twelve.